More than 7,000 children and teens are injured or killed by firearms every year. Given the steadystream of tragicnewsstories about children finding unlocked guns, you would think it makes sense for pediatricians to ask parents whether they keep their guns locked up. But doing that requires pediatricians to ask whether the parents have any guns in the first place.

In Florida, that’s against the law. At least since June 2011, when Rick Scott signed into law the Florida Privacy of Firearm Owners Act.

You might think such a law would violate the First Amendment by restricting physicians’ right to free speech. Or, at least that’s what a bunch of physicians thought. Along with several Florida doctors, the state chapters of the American Academy of Pediatrics, the American Academy of Family Physicians and the American College of Physicians sued the state of Florida for a law they claimed violated their right to free speech (which appears to include their right to pass along data in professional policy statements such as this one on firearms).

However, in a 2-1 ruling (pdf) today, a federal appeals court upheld the Florida law, arguing that a doctor’s questions about firearms violated a patient’s right to privacy. “The act simply codifies that good medical care does not require inquiry or record-keeping regarding firearms when unnecessary to a patient’s care,” the majority opinion stated.

But what is the Florida Legislature doing deciding what’s necessary or unnecessary to a patient’s care? The problem is, good medical care always requires taking into consideration ways to reduce the risk of injury or death. When we choose our doctors, we let them ask us questions about private family issues in exchange for their help managing our family’s health. There is no reason asking about firearms should be any different than asking parents whether they keep their household chemicals and medications out of children’s reach.

Professional medical associations in the U.S. agree that firearm violence represents a major public health problem in the U.S. Given that the U.S. has the highest rate of gun ownership and of firearm deaths and injuries in the developed world, it’s pretty hard to argue that point. Physicians are the stewards who help address public health issues. Arguing that a doctor’s questions about a family’s ownership of firearms violates the family’s right to privacy is akin to arguing that asking about the presence of lead paint – a standard well-child screening question – is a violation of their privacy. Why is it the doctor’s business whether a family has lead paint in their home? Because it presents a risk to children. So do firearms, so why are they any different?

The AAP thinks firearms in the home should be treated at least as seriously as lead paint. In a statement released today following the decision, James M. Perrin, MD, FAAP, the president of the AAP, said the following: “State legislatures should not stop physicians from practicing good medicine. This law has a chilling effect on life-saving conversations that take place in the physician’s office. More than 4,000 children are killed by guns every year. Parents who own firearms must keep them locked, with the ammunition locked away separately. In this case, a simple conversation can prevent a tragedy. The evidence is overwhelming – young children simply cannot be taught to overcome their curiosity about guns, and to suggest otherwise is, frankly, the height of irresponsibility.”

The president of the Florida chapter of the AAP, Mobeen Rathore, MD, FAAP, issued a similar statement: “We strongly disagree with the 11th Circuit’s decision. It is an egregious violation of the First Amendment rights of pediatricians and threatens our ability to provide our patients and their families with scientific, unbiased information. This dangerous decision gives state legislatures free license to restrict physicians from asking important questions about health and safety that are vital to providing the best medical care to patients.”

Ten other states have laws similar to Florida’s introduced in their legislatures. The plaintiffs have said they will appeal the case to the 11th circuit court.

You’ve probably heard about the Heller case, or at least heard the name “Heller.” But what was it all about, and what does it mean for gun control and gun ownership in the U.S.? One of our members, Kevin, explains.

In American government, the final word on the legality of legislation is the Supreme Court. When laws have conflicted with the Constitution, the Supreme Court has struck them down. The controversial issue of gun control is no exception. The most important gun control case in recent years (or very possibly ever) was District of Columbia v Heller.

The Supreme Court in Washington D.C. Photo courtesy of U.S. government.

Facts of the Case

The issue in Heller was a 1976 District of Columbia gun control law. This law made it a crime to possess an unregistered firearm and prohibited the registration of handguns. It further banned the possession of unlicensed handguns, with one-year licenses to be granted by the Chief of Police. The effect of these provisions was that it became illegal to possess a handgun not registered before the law took effect, and then those handguns had to be re-licensed every year. A final provision of the law required that lawfully-owned firearms be made temporarily inoperable for storage, which meant they had to be unloaded and disassembled or they had to have a trigger lock.

Heller was a D.C. special policeman who was denied permission to register a handgun that he wanted to keep at home. His suit against the law was dismissed in district court, but that decision was reversed by the D.C. Circuit Court. The U.S. Supreme Court agreed to hear the case on November 20, 2007.

Oral Arguments

In an extended oral argument, Washington D.C. argued that the Second Amendment applied specifically to a right to bear arms as part of a militia. This reading of the Second Amendment would allow virtually all forms of gun control, including the D.C. handgun ban. Concerns from several Justices over this interpretation stemmed from a belief that Congress had almost absolute authority over militias under the Constitution, including the power to disband them. It would thus be odd for the Second Amendment to prevent Congress from disarming them.

In regard to the requirement that guns be made temporarily inoperable while not in use, D.C. argued that such a requirement did not prevent the use of guns for self-defense. Both sides agreed that a right to self-defense exists, and D.C. argued that using a trigger lock would make a weapon useable in about 3 seconds, so it wouldn’t stop the owner from being able to defend himself.

Heller’s attorney argued that reasonable gun control measures were available to the government but that the handgun ban was unconstitutional because it unnecessarily infringed on a personal right to bear arms. He refuted the militia interpretation, arguing that the Second Amendment did in fact grant citizens an individual right to possess guns.

Heller’s side viewed the right to bear arms not only as an important part of the right to self-defense, but also as an inherent right enshrined in the Second Amendment and dating back to the English Bill of Rights. Additionally, the argument relied on the notion of “original intent,” the idea that the framers intended a right for individuals to bear arms under the Constitution.

The Opinion

Justice Antonin Scalia wrote the majority opinion for the Heller case. He is pictured here in 1986. Photo courtesy of senate.gov.

Justice Scalia wrote the opinion of the Supreme Court in a 5-4 decision in favor of Heller. Scalia rejected the idea that the Second Amendment was limited exclusively to militia service, recognizing both a right to possess firearms and a right to use them for lawful purposes such as self-defense.

Scalia went on to note that several forms of gun regulation are acceptable under the Second Amendment. Some examples Scalia noted include concealed weapons bans, prohibitions on firearm possession by felons or the mentally ill, prohibitions on firearm possession in places such as schools and government buildings as well as regulations on the sale of firearms.

However, Scalia found that the D.C. handgun ban as well as the so-called “trigger-lock provision” were not acceptable. He found that the ban affected a class of weapons “that Americans overwhelmingly choose for the lawful purpose of self-defense.” Similarly, he stated that the “trigger-lock provision” made it impossible for a firearm to be used in self-defense and was therefore unconstitutional. Scalia chose not to strike down the licensing requirement, noting that it is acceptable so long as it is not enforced arbitrarily or capriciously.

The Dissents

Justices Stevens and Breyer each wrote a dissent. Dissents lack the force of law, but they are often instructive in examining the issues of a case. Justice Stevens focused on the Majority’s interpretation of the Second Amendment. In his dissent, he claimed that the Amendment did not protect the use of firearms for non-military purposes. Justice Stevens argued that the Majority had set aside normal standards of interpretation in its decision. He believed that the Majority had inappropriately ignored the first part of the Amendment: “A well regulated Militia.”

He also cited the term “bear arms” as meaning “to serve as a soldier, to do military service, to fight,” according to the Oxford English Dictionary. In other words, his reading was that the right was tied inextricably to military service. Justice Stevens also presented historical evidence to counter the Majority’s claim of original intent, including a 1792 militia bill that required every white male of suitable age to “provide himself with a good musket or firelock.” That requirement to own a gun also suggests a military purpose.

Justice Breyer agreed with Justice Stevens’ reading of the Second Amendment, but he added that the right is not absolute. Justice Breyer appeared to be assessing the balance between state interest and individual rights — whether the state interest in gun regulation overrode any individual right to own a gun for military purpose. He said the D.C. law pursued government interests in protecting life and preventing crime, both repeatedly found to be compelling interests. Justice Breyer therefore found there was sufficient government interest served in the law, so it should have been upheld.

Aftermath

Following the Heller decision, D.C. began changing its gun laws. An amendment to firearms regulations relaxed several hurdles to gun registration, and provided for the creation of a list of “unsafe” handguns that could not be registered. The law kept a ban on automatic weapons and bottom-loading guns, which has already been challenged in court.

The ruling in Heller was extended when the Supreme Court ruled that the Second Amendment applied to the states as well as the federal government in McDonald v Chicago. That case caused a Chicago handgun ban to be returned to lower courts for a ruling in line with Heller.

There is not yet a consensus on what exactly Heller means for gun control. Some have called this victory for gun rights activists a hollow one because it affirmed that there are many regulations consistent with the Second Amendment. The media has often portrayed the case as an absolute recognition of gun rights, but the Court’s majority opinion is more nuanced.

What Does It All Mean?

Heller is not the clear-cut case that some would like it to be. While it threw out certain provisions of the D.C. gun control law, it also explicitly recognized the possibility of others. In his opinion, Justice Scalia did not produce any sort of Constitutional test by which laws could be measured. The future of the field of gun control laws seems destined to be determined by more lawsuits.

However, a good understanding of the Heller case is essential for anyone advocating for new gun legislation that would remain consistent with the modern interpretation of the 2nd Amendment. The regulations specifically articulated by Justice Scalia would certainly be acceptable, and the oral arguments during the case reveal other regulations that also seemed acceptable to the Court, such as “safe storage” laws. Further, Heller did not rule out bans on certain classes of weapons. Justice Scalia emphasized handguns because they are so widely used in self-defense. An assault weapons ban could very possibly be found constitutional and consistent with the Heller opinion.

Likely the most important lesson from this case is that gun regulations must take individual liberty into account. The interpretation that individuals’ right to bear arms was limited to a military role only was dismissed in Heller. The case left room for a balance between gun rights and gun regulation.

The policy proposals that President Obama announced on Wednesday (organized by category here) outlined a wide-ranging agenda, including twenty-three items that could be implemented through executive action and twelve recommendations for action from Congress.* The items are a mixed bag, ranging from immediately actionable ideas to proposals that may never make it through Congress. Some are vague (launching a national dialogue about mental illness) while others are very specific (confirming a director for the ATF). In the coming weeks, PAGV will explore, seek input on, and respond in detail to the specific items. Here we outline a few of our immediate reactions as parents and concerned citizens.

This is an important first step. It is gratifying to see the President both take direct action on a number of important gun-related matters, and publicly initiate the conversation about what needs to change to address the ongoing epidemic of gun violence in the United States.

We strongly agree with the need fora comprehensive legislative and executive agenda, one that attempts to solve gun violence by addressing gun access, gun safety, school safety, societal factors, and mental illness. Reducing the threat of violence to our children will clearly require such a broad-based, comprehensive effort. Any flaws in individual proposals do not invalidate the entire effort.

There will be something for everyone to like, and for everyone to hate, in the proposals. Given the current political climate, this may be inevitable. Due to the absence of thorough research into the causes and effects of gun violence, there is little agreement about its remedies, beyond a desire to see it end. To some, allocating $10,000,000 to research the connection between video games and violence seems like the worst kind of pandering to the NRA’s “it’s-everything-but-the-guns” narrative. To others, requiring background checks on all gun sales seems like the first step in a government takeover.

Some of the proposals concur in fundamental ways with recent policy proposals from Parents Against Gun Violence. One of the executive orders, for example, directed the Centers for Disease Control to initiate research into the health effects of gun access (PAGV Policy Plank #2, Empower Researchers), while a proposal to Congress urges legislators to allocate $30,000,000 for schools to develop emergency-response plans (Policy Plank #5, Protect Schools).

While President Obama implemented a number of executive actions, the biggest proposed changes will all require legislative action. All of the major funding allocations (with the exception of $20 million to encourage states to share background data) also have to go through Congress. In the coming weeks, concerned parents and citizens need to make sure that our voices and perspectives are heard in the legislative debates.

* Note that Obama actually signed only three executive orders (technically “presidential memorandums“) on Wednesday. The 23 “executive actions” named in the Obama proposal describe general policy priorities that would not require Congressional approval for implementation. However, many of the proposed “executive actions” come far from implemented (or implementable) public policy at this point.

Parents Against Gun Violence was founded by a nationwide coalition of mothers and fathers hours after the Newtown, CT killings. In the weeks that followed, our members were busy collecting and studying scientific, peer-reviewed research on the causes of gun violence and gun accidents, and strategizing about how to reduce both.

At the same time, we have engaged in intensive dialogue with concerned citizens from across the political spectrum. Through this process of research and dialogue, we have developed a set of five policy planks that we believe can gain support across the political spectrum, and that provide a comprehensive approach to reducing gun violence. We encourage all concerned citizens to contact their representatives, senators and any other elected officials as well to advocate for these policy proposals. If you would like to sign the petition promoting this platform, click on the Change.org petition here.

As parents, we urge lawmakers and the President to consider the following:

Policy Plank 1.) Empower law enforcement

a.) Approve Andrew Traver, President Obama’s nominee for Director of the Bureau of Alcohol, Tobacco Firearms and Explosives. Without a leader, the Bureau is hampered in its ability to enforce its congressionally mandated responsibilities, such as investigating and prosecuting straw purchasers who buy guns for criminals. More »

For the thousands of Americans who die each year by gun suicide and gun accidents, these bills will have little effect—one bullet is enough to kill. There is ample evidence, however, to suggest that an effective ban on high-capacity magazines will reduce the number of deaths in gun homicides, especially in mass shooting scenarios.

This graph reveals the correlation between magazine capacity and number of casualties during mass shootings in recent history.

A seven-year-long study of gunshot victims observed an increasing incidence of gunshot victims who had been shot multiple times. The proportion of gunshot victims with two or more gunshot wounds grew from 26% in the early 80s to 43% by 1990[1]. Over the same span of years, semiautomatic handguns like the Beretta 92 and Glock 17 were replacing the .38 and .357 caliber revolvers that had been the most popular handguns in the United States in the preceding decade. The ammunition capacity in a fully-loaded handgun rose from typically six rounds to typically 15 rounds, and shooters exploited that advantage, shooting their victims multiple times and increasing the likelihood of fatal injury.

Parents Against Gun Violence researchers have identified 37 mass shooting incidents (excluding robberies and armed confrontations) involving more than 6 victims in the United States since 1945. In 35 of 37, the perpetrators carried semiautomatic weapons. In 33 of 37, the perpetrators carried magazines with a capacity greater than 10 rounds. In the recent mass shootings in Tucson, Aurora, and Newtown, the perpetrators sought out inordinately large magazines, including the 100-round drum magazine James Holmes used to shoot 70 people in a movie theater. These mass murderers clearly believe that a higher-capacity magazine will equate to more fatalities.

Opponents of the high-capacity magazine ban will point out that smaller capacity magazines can be rapidly exchanged, and will argue that such a ban will not slow or hinder a mass shooter. Online videos show expert shooters removing an empty magazine and replacing it with a fully loaded magazine with dazzling speed. Let’s remember, though, that these videos are impressive precisely because the reloading skills depicted are remarkably rare—it takes years of practice to achieve such proficiency, and the perpetrators of most mass shootings are young men with limited experience. There are cowboy trick shooters who can operate a single-action revolver or lever-action rifle with astonishing speed—but Annie Oakley doesn’t fit the profile of a mass shooter. We’re not seeking laws to stop Wild Bill; we’re seeking laws to stop Jared Loughner. More »

We’ve been covering a lot of medical association news related to the Newtown shooting and gun-related legislation, but that’s because we’re very focused on looking at what research can tell us about reducing firearm injury, and medical associations are closely involved with much of this research.

The organization had published a report on firearm-related injuries affecting children in their journal Pediatrics in October, in which they wrote “The American Academy of Pediatrics continues to support a number of specific measures to reduce the destructive effects of guns in the lives of children and adolescents, including the regulation of the manufacture, sale, purchase, ownership, and use of firearms; a ban on semiautomatic assault weapons; and the strongest possible regulations of handguns for civilian use.”

Unsurprisingly, in their letter to political leaders, they were just as direct regarding policy proposals related to gun control, mental health and children’s exposure to violence:

• ”New federal firearms legislation that bans assault weapon sales and the sales of high capacity magazines, strengthens mandatory waiting periods and background checks for all gun purchases and promotes strict gun safety policies is a necessary first step.
• Next, the federal government must take action to improve access to services that meet the mental health and developmental needs of infants, children and adolescents, and ensures that children and families exposed to violence have access to a medical home and other community supports.
• Finally, we must engage in a national dialogue designed to reduce children’s detrimental exposure to violence in their communities, environments and entertainment.”

We’ll be revisiting the full account of their policy report on firearms for a later blog post, but we also wanted to mention another article with similar recommendations. “Weapons of Mass Destruction,” published in the Archives of Internal Medicine, which is published by the American Medical Association, also offered commentary related to firearm regulation. More »

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